摘要
目的探讨同时保留膀胱颈和前列腺尖部尿道黏膜的经尿道前列腺等离子剜除术对良性前列腺增生(BPH)患者术后逆行射精发生率的影响。方法回顾性分析2018年1月至2020年6月金华市人民医院收治的77例BPH患者的临床资料。77例排尿困难均>1年,伴尿线变细、夜尿增多等下尿路不适症状,口服药物治疗症状无改善。术前尿动力学或影像学检查均未发现神经源性膀胱、膀胱过度活动症、前列腺恶性肿瘤、逼尿肌无力等。常规经尿道前列腺等离子剜除术者为常规组(35例),同时保留膀胱颈和前列腺尖部尿道黏膜的经尿道前列腺等离子剜除术者为改良组(42例),两组的年龄[(62.06±2.01)岁与(62.36±2.12)岁]、国际勃起功能指数(IIEF-5)(均≥22分,勃起功能均正常)、前列腺体积[(72.91±17.57)ml与(68.07±17.28)ml]、最大尿流率(Qmax)[(7.33±2.02)ml/s与(7.79±2.09)ml/s]、国际前列腺症状评分(IPSS)(25.51±5.66与25.17±4.90)比较差异均无统计学意义(P>0.05)。常规组采用"三叶法"剜除前列腺。改良组在常规手术方法上进行改良:①距精阜内侧表面1.0~1.5 cm离断精阜前黏膜,避免损伤精阜;②在离断两侧叶腺体时不超过精阜,保留部分前列腺组织和黏膜;③用电切镜鞘钝性剥离增生中叶直至膀胱颈处,离断时保护好膀胱颈横行肌纤维,保留膀胱颈的完整性。比较两组患者手术疗效和术后射精功能的指标。结果常规组与改良组的手术时间[(66.74±9.29)min与(71.29±15.32)min]、导尿管留置时间[(5.31±0.76)d与(5.00±1.06)d]、住院时间[(7.57±0.88)d与(7.17±1.45)d]差异无统计学意义(P>0.05)。两组术后随访均≥6个月,术后6个月常规组和改良组轻度勃起功能异常发生率分别为20.7%(6/29)与13.5%(5/37),差异无统计学意义(P>0.05);两组的Qmax分别为(23.51±4.25)ml/s和(24.05±3.81)ml/s,IPSS分别为6.46±2.72和6.55±2.99,与术前比较差异均有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。常规组和改良组逆行射精发生率分别为65.7%(23/35)和31.0%(13/42),差异有统计学意义(P<0.05)。常规组和改良组术后即时尿控率分别为68.6%(24/35)和85.7%(36/42),差异无统计学意义(P>0.05),术后6个月两组尿控率均为100.0%。结论同时保留膀胱颈和前列腺尖部尿道黏膜的经尿道前列腺等离子剜除术治疗BPH的效果与常规经尿道前列腺等离子剜除术相当,但术后逆行射精发生率明显降低,可用于需要保留正常射精功能的患者。
Objective To investigate the effect of transurethral plasma enucleation of prostate with bladder neck and prostatic apex urethral mucosa preservation on the incidence of retrograde ejaculation after surgery.Methods The clinical data of 77 patients with benign prostatic hyperplasia(BPH)admitted to Jinhua people's Hospital from January 2018 to June 2020 were retrospectively analyzed.The ages of the two groups[(62.06±2.01)years old and(62.36±2.12)years old]were comparable.There were no significant differences between the groups(P>0.05)in term of the prostate volume(72.91±17.57)ml vs.(68.07±17.28)ml,Qmax[(7.33±2.02)ml/s vs.(7.79±2.09)ml/s)],and IPSS(25.51±5.66)vs.(25.17±4.90).The conventional operation group was treated with"trefoil"enucleation of prostate.The modified operation group underwent the following three improved techniques.Firstly,the anterior mucosa of the verumontanum was cut 1.5 cm away from the medial surface of the verumontanum to prevent the external sphincter injury.Secondly,part of the prostate tissue was retained by exceeding the verumontanum when cutting off the bilateral lobes.Thirdly,the middle lobe of the prostate was bluntly stripped to the bladder neck with the sheath of the electroscope in order to protect the transverse muscle fibers as well as the integrity of the bladder neck.The outcome and the ejaculation function of the two groups were analyzed.Results There was no significant difference in operation time[(66.74±9.29)min vs.(71.29±15.32)min],catheter indwelling duration[(5.31±0.76)d vs.(5.00±1.06)d],and hospital stay[(7.57±0.88)d vs.(7.17±1.45)d]between the two groups(P>0.05)after more than 6 months of follow-up.According to IIEF score,mild erectile dysfunction occurred in both groups,with the incidence rate of 20.7%(6/29)and 13.5%(5/37)respectively,and there was no significant difference between the two groups(P>0.05).The postoperative maximum urinary flow rate(Qmax)[(23.51±4.25)ml/s vs.(24.05±3.81)ml/s]and IPSS score(6.46±2.72 vs.6.55±2.99)was significantly different from that before the operation(P<0.05).However,there was no significant difference between the two groups(P>0.05).The incidence of retrograde ejaculation in conventional operation group and modified operation group was 23/35(65.7%)and 13/42(31.0%),and the difference was statistically significant(P<0.05).Immediate urinary continence were 24/35(68.6%)and 36/42(85.7%)in the conventional operation group and the modified operation group respectively,and there was no significant difference between the two groups(P>0.05).After 6 months of follow-up,urinary continence in both groups was 100.0%.Conclusions Transurethral plasmakinetic enucleation of the prostate with the preservation of bladder neck and urethral mucosa of prostate apex is the same effective as conventional operation in the treatment of benign prostatic hyperplasia,but the incidence of retrograde ejaculation after operation is significantly reduced,which is suitable for those patients who desire to retain their ejaculation function.
作者
黄益平
吴慧玲
何桂兵
张春霆
Huang Yiping;Wu Huiling;He Guibing;Zhang Chunting(Department of Urology,Jinhua People’s Hospital,Jinhua 321000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第2期132-136,共5页
Chinese Journal of Urology
基金
金华市科学技术研究计划重点项目 (2020-3-054)。
关键词
前列腺增生
前列腺剜除术
射精功能异常
Prostate hyperplasia
Prostate enucleation
Retrograde ejaculation
